Trends in Online Searches for Oral and Maxillofacial Surgery During the COVID-19 Pandemic
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Trends in Online Searches for Oral and Maxillofacial
Surgery During the COVID-19 Pandemic
shinichi sato ( first.sato@gmail.com )
Japan Community Health Care Organization Sendai Hospital https://orcid.org/0000-0002-2133-1330
Masato Takahashi
Japan Community Healthcare Organisation Sendai Hospital
Tetsu Takahashi
Tohoku University Graduate School of Dentistry School of Dentistry: Tohoku Daigaku Daigakuin
Shigaku Kenkyuka Shigakubu
Research
Keywords: COVID-19, Temporomandibular joint, Dental implants, Jaw fractures
Posted Date: July 20th, 2021
DOI: https://doi.org/10.21203/rs.3.rs-714303/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
Read Full License
Page 1/13Abstract
Background: Dentists and dental staff involved in oral and maxillofacial surgery (OMS) are at high risk of
infection during the coronavirus disease (COVID-19) pandemic. Therefore, prevention of viral infection is
essential in OMS, and attention should be paid to the trends in OMS during COVID-19. In this study, we
aimed to investigate the search trends in OMS during the COVID-19 pandemic using Google Trends (GT).
Methods: COVID-19 was considered prevalent from December 2019, and the search period on GT was set
to 1 year (January 1, 2020–January 1, 2021). We observed trends for the following OMS-related terms:
“wisdom teeth,” “TMJ” (temporomandibular joint), “dental implants,” “jaw surgery,” and “jaw fracture.”
Additionally, the terms “aerosol” and “PPE” (personal protective equipment) were also used in the study.
We identified the top five countries for all the aforementioned terms to confirm the trends by country. The
multivariate Steel–Dwass test was used to compare the relative search volume (RSV) of the OMS-related
terms, and the Mann–Whitney U test was used for comparison between the two groups of the COVID-19
prevention terms “aerosol” and “PPE.”
Results: The RSV showed a decreasing trend from March to April for the terms “wisdom teeth,” “TMJ,”
and “dental implants”; however, there was an increasing trend for the same terms from May onward. The
term “PPE” showed a sharp increase from March to April. In comparison by country during the 1-year
period, the United States had the highest RSV for “wisdom teeth” and “jaw fracture,” and Malaysia had the
highest RSV for “TMJ.” Similarly, the highest RSV for “dental implants” and “jaw surgery” was in Laos
and Canada, respectively.
Conclusions: The COVID-19 pandemic may have altered the search trends for the terms “wisdom teeth,”
“TMJ,” and “dental implants”.
Background
Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome
coronavirus 2 that emerged in December 2019 and has been confirmed to be prevalent globally [1, 2].
The main modes of infection include direct infection by droplet inhalation through coughing and contact
infection through mucous membranes, such as that of the mouth, nose, and eyes [3].
Healthcare workers, in particular, have a greater chance of getting infected with the virus through patients.
To date, 29% of general healthcare workers have reportedly been infected [4]. Dentists and dental staff
are also at a high risk of infection [5], especially those belonging to the specialization of oral and
maxillofacial surgery (OMS) [6].
Therefore, prevention of viral infection is essential in OMS, and attention should be paid to the trends in
OMS during COVID-19.
Page 2/13In Google Trends (GT; Alphabet Inc., Mountain View, California, United States), when a search term is
entered, the data of the search term is displayed as relative search volume (RSV) from 0 to 100. The peak
of the search term is 100; e.g., an RSV of 50 means that a term is half as popular as the peak search term
at that time. The geographical search volume is not an absolute number, but a percentage of the total
number of searches in a location [7–12].
Trends in OMS have previously been reported using GT [7]; however, there have been no reports on the
change in the trends during the COVID-19 pandemic. Additionally, in the field of OMS, COVID-19
prevention is important for a safe work environment, and it is particularly necessary to pay attention to
“aerosol” and personal protective equipment (“PPE”) [13].
Further, knowing the changes in OMS trends during the COVID-19 pandemic is important to understand
the public’s interest in the field.
In this study, we investigated the search trends in OMS during the COVID-19 pandemic period (2020)
using GT.
Methods
Data source
GT was used to collect data on online search trends. Entering the terms "wisdom teeth," "TMJ"
(temporomandibular joint), "dental implants," "jaw surgery," "jaw fracture," "aerosol," or "PPE" yielded RSVs.
The RSV is based on normalized search data and is presented on a scale from 0 to 100, with 100
representing the maximum number of searches in a given time period. [7-12].
Evaluation period
COVID-19 is considered to have been prevalent since December 2019, and the evaluation period of 1 year
was defined as January 1, 2020, to January 1, 2021.
Search terms
We used the search terms “wisdom teeth,” “TMJ” (temporomandibular joint), “dental implants,” “jaw
surgery,” and “jaw fracture,” which have been used as OMS terminologies from 2004 to 2019 [7].
Additionally, the terms “aerosol” and “PPE,” which are relevant for COVID-19 prevention in the field of
OMS, were also used in this study.
Geographic trends
Page 3/13The five countries with the highest search numbers for the terms “wisdom teeth,” “TMJ,” “dental
implants,” “jaw surgery,” “jaw fracture,” [7] “aerosol,” and “PPE” were used to identify the trends by country.
Statistical analysis
Statistical analysis was performed using BellCurve for Excel (Social Survey Research Information Co.,
Ltd.) to analyze the results of the OMS-related terms.
For comparison between the RSVs of the OMS-related terms, the multivariate Steel–Dwass test was used,
and for comparison between the two groups of the COVID-19 prevention terms “aerosol” and “PPE,” the
Mann–Whitney U test was used. A P-value ≤.05 was considered statistically significant.
Results
Figure 1 shows the RSV for the terms “wisdom teeth,” “TMJ,” “dental implants,” “jaw surgery,” and “jaw
fracture” from January 1, 2020, to January 1, 2021. The RSV for the term “wisdom teeth” dropped sharply
in April; however, it has remained around 80 since May.
Figure 2 presents the box-and-whisker diagrams for the terms “wisdom teeth,” “TMJ,” “dental implants,”
“jaw surgery,” and “jaw fracture.” Searches for “wisdom teeth” (median 76) were higher than that for
“TMJ” (median 43.5). The bulk search for “dental implants” (median 33.5) was significantly different
from that for “TMJ” (median 43.5), “dental implants” (median 33.5), “jaw surgery” (median 6), and “jaw
fracture” (median 1). The RSV for “TMJ” was significantly different (P < 0.01) from that for “dental
implants,” “jaw surgery,” and “jaw fracture.” There was a significant difference (P < 0.01) among “dental
implants,” “jaw surgery,” and “jaw fracture.”
Figure 3 shows the trend of the RSV for “aerosol” and “PPE” from January 1, 2020, to January 1, 2021.
The RSV of PPE increased from March to April.
Figure 4 shows the box plots for aerosols and PPE. There was a significant difference between aerosol
(median 14) and PPE (median 23).
Table 1 shows the geographical trends of OMS-related terms from 2004 to 2019 and 2020 and that of the
COVID-19 prevention-related terms in 2020. The country that most frequently searched for “wisdom teeth”
and “jaw fracture” was observed to be the United States from 2004 to 2019 and was the same in 2020.
This position for “TMJ” was held by Malaysia from 2004 to 2019 and was the same in 2020. The term
“dental implants” was most searched by St. Helena during 2004 to 2019 and by Laos in 2020. The
country that searched for “jaw surgery” the most was Singapore during 2004 to 2019 and Canada in
2020. For “aerosol,” the countries in descending order of the RSV were Argentina, Paraguay, Mexico, Italy,
and Uruguay. For “PPE,” the countries in a similar order were the Philippines, the United Kingdom, South
Africa, Ireland, and Nepal.
Page 4/13Discussion
COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020 [14]. Following
this declaration, there was a decrease in the RSV for “wisdom teeth,” “TMJ,” and “dental implants”;
however, an increase in these RSVs was observed after May. This might have been attributed to patients
refraining from undergoing surgery to prevent infection during the spread of COVID-19.
One of the characteristics of the year 2020 has been the rapid increase in the RSV of “PPE,” and the
interest in “PPE” was especially high during April and May. In contrast, following the decrease in the RSV
of “PPE” in June, the RSV of “wisdom teeth,” “TMJ,” and “dental implants” showed an increase. These
trends denote that in April and May, the focus was on PPE with an aim of infection prevention; however,
from June onward, the conditions relating to the pandemic had improved, and procedures involving
“wisdom teeth,” “TMJ,” and “dental implants” had restarted.
In the RSV comparison for OMS terms, the median value for “wisdom teeth” was 76 throughout the year,
which was higher than that of “TMJ,” “dental implants,” “jaw surgery,” and “jaw fracture,” even during the
COVID-19 pandemic, suggesting the high demand for the treatment of “wisdom teeth.”
The geographic trends of search terms in 2020 are the same as those from 2004 to 2019, with an
increase in the number of searches in the United States, Australia, New Zealand, and the United Kingdom
after the start of the COVID-19 pandemic, suggesting that OMS continues to be practiced in the regions
considered to be developed countries and that the environment allows easy access to the Internet.
The country with the highest number of searches for “dental implants” in 2020 was Laos. In Laos, as well
as in St. Helena, the country with the highest number of searches for the same term from 2004 to 2019, a
part of the population is highly interested in “dental implants,” which might have led to the increased
number of searches.
Regarding the trends for terms related to COVID-19 prevention, four of the top five countries for “aerosol”
searches were from Latin America. This suggests that Latin America has actively educated its population
about COVID-19 prevention. The RSV for “PPE” was observed to be high in the Philippines, the United
Kingdom, South Africa, Ireland, Nepal, Southeast Asia, Northern Europe, Africa, and a wide area of the
world where COVID-19 prevention has been considered important. This study is a useful collection of
information for establishing guidelines for patients with COVID-19 in OMS [15].
One of the limitations of this study is that the only search engine used was Google; however, this decision
was based on the fact that Google is the most widely used search engine worldwide. Furthermore, the
RSVs retrieved from GT showed only relative search interest and not the absolute total number of
searches. The total number of searches by country was also unknown. The data obtained are useful to
show the general search trend by country, but it should be noted that a high number of searches in a
country with a small population may result in a high RSV. In addition, since the search terms evaluated in
Page 5/13this study were in English, the results do not reflect differences in language. In non-English speaking
countries, the number of people using English terms on search engines online may be low.
However, we were able to learn about the search trends for "wisdom teeth," "TMJ," "dental implants,"
"aerosol" and "PPE" during the COVID-19 pandemic, which is meaningful information to examine whether
the measures taken so far have been effective.
Conclusion
The results of the present study indicate a change in interest in terms related to OMS during the COVID-19
pandemic. Furthermore, during the COVID-19 pandemic, RSV increased for the terms "wisdom teeth,"
"temporomandibular joint," and "implant," whereas no change was observed for the terms "jaw surgery"
and "jaw fracture." This change in the online interest for these three keywords suggests that the COVID-19
pandemic may have resulted in a change in the search trends for these terms.
Abbreviations
COVID-19: Coronavirus disease; GT: Google Trends; OMS: Oral and maxillofacial surgery; PPE: Personal
protective equipment; RSV: Relative search volume; TMJ: Temporomandibular joint
Declarations
Ethics approval and consent to participate: Not applicable.
Consent for publication
Not applicable.
Data Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Competing interests
The authors declare that they have no conflicts of interest with respect to the publication of this paper.
Funding
This report did not receive any specific grant from funding agencies in the public, commercial, or not-for-
profit sectors.
Authors’ contributions
Page 6/13SS conceived this report, drafted the manuscript, and critically revised it for important intellectual content.
TM and TT helped draft the manuscript. All authors read and approved the final manuscript.
Acknowledgments
We would like to thank Editage (www.editage.com) for editing the English version.
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Tables
Table 1
Page 8/132020–2021 2004–2019
Search term Country (%*) Country (%*)
Wisdom teeth United States (100) United States (100)
Jamaica (81) Canada (84)
Canada (77) Australia (81)
Australia (75) New Zealand (70)
New Zealand (72) Ireland (59)
TMJ Malaysia (100) Malaysia (100)
Canada (87) United States (66)
United States (70) Canada (47)
Australia (53) Philippines (39)
New Zealand (41) Australia (34)
Dental implants Laos (100) St Helena (100)
United Kingdom (47) Ireland (22）
United States (45) United States (21)
Vietnam (41) United Kingdom (19)
Ireland (32） Australia (16)
Jaw surgery Canada (100) Singapore (100)
Australia (80) Canada (72)
Ireland (76） Australia (61)
United States (72) Ireland (60)
Singapore (69) United States (57)
Jaw fracture United States (100) United States (100)
Australia (67) Australia (92)
United Kingdom (66) Canada (74)
Ireland (61） United Kingdom (73)
India (46) India (64)
Aerosol Argentina (100)
Paraguay (74)
Mexico (73)
Page 9/13Italy (69)
Uruguay (52)
PPE Philippines (100)
United Kingdom (86)
South Africa (82)
Ireland (72）
Nepal (58)
(％*): Percentage of popularity in country compared with most popular location for term (100).
Wisdom teeth, TMJ, dental implants, jaw surgery, and jaw fracture from 2004 to 2019 and geographic
trends in 2020 and aerosol and PPE geographic trends in 2020. TMJ temporomandibular joint,
PPE personal protective equipment
Figures
Page 10/13Figure 1 Google Trends RSV from January 1, 2020, to January 1, 2021. The term “wisdom teeth” showed a downward trend from March to April, but an upward trend since May is seen. TMJ: temporomandibular joint; PHEIC: Public Health Emergency of International Concern Figure 2 Box plot is shown. × indicates an outlier. **: p
Figure 3
Google Trends RSV from January 1, 2020, to January 1, 2021. The term “PPE” shows a sharp increase
from March to April and a downward trend from April. PPE: personal protective equipment; PHEIC: Public
Health Emergency of International Concern
Page 12/13Figure 4
The box plots for aerosols and PPE. PPE: personal protective equipment. There was a significant
difference between aerosol (median 14) and PPE (median 23).
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